Anywhere a large crowd congregates, the need for a well-prepared emergency medical team is present. To provide the best possible service to their communities, it is essential that EMS agencies covering concerts and other large gatherings take all the risk factors into consideration and make sure the proper equipment and resources are in place to address all potential scenarios.
MONOC EMS, headquartered in Wall, NJ, provides standbys as well as active MCI-style response to a wide spectrum of events. These include small gatherings like funerals, health fairs, sporting competitions and community events, which require only single BLS units, and larger crowds such as at concerts and theme parks, involving thousands of people.
In both scenarios, it is important to be prepared for the worst, because you never know what you'll get. The overcrowded heavy-metal concert may prove to be completely uneventful, while the small-town bingo game can yield more patients than ever imagined. Either way, it's imperative to have all potentially needed equipment at the ready, even if it's not directly on site. If your service takes on the responsibility of such events, you'll be squarely in the public eye--either making positive, professional impressions, or rubbing people the wrong way.
There are several important factors to keep in mind when taking on special event work:
Professional appearance: It is imperative that staff look professional. If climate and conditions permit, it's a good idea to utilize Class A dress uniforms. (Of course, if it's expected to be 90-degree weather with 95% humidity, opt for the cooler short-sleeve shirts.) Short pants, regardless of weather, are a bad idea: EMS providers will be working outdoors, kneeling on pavement, gravel, etc. Shorts can be a certain knee-scraper. Some services use alternative uniforms for special events, but this can be counterproductive--if an employee fails to show up, a supervisor will have to find a replacement with the proper uniform, which may not have been furnished to all employees. Another point to consider is that regular duty uniforms were developed to display an agency's patches and certifications, and represent the image the service wants to portray to the public. Using an inexpensive golf-type shirt defeats this purpose.
Drugs/alcohol: At events where alcohol is served, you might expect to encounter injuries from fights, falls, etc., as well as cases of acute intoxication. Plans must be in place for utilizing security staff or the local police. Often, a mere police presence can help persuade uncooperative patients to go to the hospital. Concert EMS staff should be educated on ways to assess and treat patients who have overdosed on street and designer drugs such as LSD, PCP, ecstasy, GHB or even nitrous oxide. There have also been cases where concertgoers have maliciously exposed EMS providers, police and security to drugs. Therefore, inform staff to be extremely cautious to not accept food or water from the public, allow themselves to be sprayed, etc.
Specialized equipment: Different events require different equipment. For example, to provide emergency services at an offshore powerboat race, it is necessary to provide staff with personal flotation devices and waterproof radio protectors. At the local auto track, they'll need hearing and eye protection, turnout gear and shoes with oil-resistant soles. At a nighttime event with a large crowd, it is a good idea to give providers small chemical light sticks that attach to uniforms with safety pins. These serve a couple of purposes: They help the public quickly identify EMS providers if they're needed, and they can serve as safety beacons for providers needing assistance. It can be difficult to identify exact locations in calling for help over the radio; light sticks can be easily picked out of a large crowd.
Because large crowds often come with large noise, special noise-canceling radio headsets are a wise investment for reliable communications. When selecting headsets, try them on, and consider that they'll likely be worn for extended periods in the hot sun and should be as comfortable and nonrestrictive as possible.
Patient movement devices are necessary but not always feasible, yet carrying patients for long distances can be a nightmare for your employees. Consider specialized solutions such as wheelchairs, rescue sleds, golf carts, bicycles, etc. While these can be expensive, they can prove invaluable. Modified golf carts and Gator-type all-terrain vehicles can cost up to $20,000 but are a must at places like theme parks and large concert halls, where ambulances might be unable to navigate through crowds or down small passageways.
Boston EMS has been successful using single-provider Segways to move paramedics through crowds at the annual Boston Marathon, and EMS in Chicago utilizes them during special events in their downtown and lakefront areas. They carry cardiac monitors and defibrillators, obstetrical kits, advanced airway supplies, pharmaceuticals and other lifesaving equipment in detachable packs. The Segways are not only an excellent way of getting to victims quickly, but also a good public relations tool.
Agencies in coastal areas might benefit from the use of boats or personal watercraft. These can be crucial to gain rapid access to patients. But remember, simply acquiring a specialized vehicle or piece of equipment doesn't mean just anyone can operate it. Some states require motor vehicle licensing for personal watercraft and boats, and the industry standard for police and EMS personnel using bicycles is training and certification by the International Police Mountain Bike Association.
Health and safety: When planning for any event, it is essential to provide for restroom facilities, private break areas (preferably air-conditioned or heated, as appropriate), food and, most important, water. If a safety officer is designated, their first task should be to ensure that all teams of providers have been provided clean, preferably cold water. Having this on hand will keep them hydrated and eliminate a need for unscheduled breaks.
Because outdoor concerts and special events often occur in hot weather, consider what type of food is provided for emergency personnel and how it will be stored. If refrigeration is not available, rule out foods that will easily spoil. Use sunblock to prevent burns and skin problems. In cold or rainy weather, while it may not be possible for providers to remain in shelter, they should have good-quality outerwear. Waterproof boots are essential--nothing slows an employee like cold, wet or blistery feet.
Resource planning: Someone is paying for the services provided at concerts and special events, and these people are trying to manage budgets. They become frustrated with unplanned last-minute add-ons (additional generators when they thought power would be provided, portable fencing, additional security, etc.). Of course, event promoters often think emergency medical services are provided at low cost or for free because they've dealt with volunteers or other agencies with low overhead. These volunteer services may be compensated with perks like free tickets for their families, free food, event memorabilia, etc.
Unfortunately, providing service proficiently requires a certain amount of expertise. This is not to say volunteer services don't have it, but unless they are acclimated to the challenges of mass-gathering events and the host venues and their pitfalls, someone else might better maximize chances of a safe event. Many colleges have volunteer EMS, and their crews have become very experienced in providing service at sporting events, concerts, etc. They know what to expect, are familiar with routes to hospitals and have proper communications with law enforcement. But a big event coming to a small town that has never had anything similar could present some real tribulations.
If an agency provides regular service to the same venue, it is a good idea to set forth standards with the owner, manager or promoter. For example, MONOC routinely provides services at concerts at the local PNC Bank Arts Center. It worked with management there to develop service-level guidelines based on event attendance (See Table 1). These can change based on things like patron demographics, potential alcohol sales and weather forecasts.
- Attendance: 0-7,000 Minimum EMTs: 4 Minimum Supervisors: 1 Minimum Paramedics: N/A
- Attendance: 7,000-12,000 Minimum EMTs: 7-12 Minimum Supervisors: 1 Minimum Paramedics: TBD
- Attendance: 12,000-17,500 Minimum EMTs: 12-22 Minimum Supervisors: 2 Minimum Paramedics: 2
It is easy to be influenced by the event promoter or venue operator when planning resources. To keep costs low and profits high, they are motivated to have minimal EMS staffing, while the EMS agency is prudent to have more than what is needed, to ensure preparedness for the unknown. At its local venue, MONOC experiences a specific annual event that taxes its resources. With proper planning, it is often necessary to demand the venue pay for adequate resources. It is the patrons at the event and the EMS agency that will suffer if proper personnel, vehicles and supplies are not immediately available.
Understand and accept that EMS cannot do everything to ensure a safe environment for event patrons. Communications with other entities are essential to ensure other vital tasks are completed. Without law enforcement, unruly patients can harm those attempting to care for them. Without traffic control, emergency vehicles may not be able to access necessary areas or egress to hospitals. Maintaining relationships with not only ranking officers and management, but line staff as well can be useful when dealing with police, fire, vendors and staff. If you're nice to the stadium beer vendors, for instance, they'll be more likely to help you if you need ice.
Working with law enforcement, fire, hazmat, venue staff and others to develop an emergency plan will be an arduous task. But if tragedy strikes, it will help you mitigate whatever the disaster is. From 1992-2002, there were 232 deaths at concerts and festivals around the world, and more than 66,000 injuries.
Planning for concerts or special events requires an EMS agency to consider many factors and utilize any resources available to ensure the event remains safe and orderly. The best scenario is for all workers, like all attendees, to leave with only good memories of the event.
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Andrew T. Caruso has been involved in New Jersey EMS for over 20 years as both a volunteer and career provider. He has spent the last 10 years at MONOC EMS; first as a dispatcher and ultimately in his current position as director of operations. One of his responsibilities since starting at MONOC is overseeing the different types of special event contracts including The PNC Bank Arts Center, a 17,500-capacity amphitheater. He can be reached at firstname.lastname@example.org.